Analyse des freins à l’usage de l’électrocardiogramme chez les médecins généralistes installés en Ile-de-France : étude qualitative basée sur la méthode des focus groups

Objectifs : L’ECG est un outil diagnostique nécessaire dans de nombreuses indications rencontrées en médecine générale, il est pourtant peu utilisé. Notre objectif principal était d’analyser les freins à l’usage de l’ECG ressentis par les médecins généralistes, l’objectif secondaire de proposer des pistes pour essayer de lever ces freins.Méthode : Nous avons eu recours à une méthode qualitative avec l’organisation de 2 focus groups de médecins généralistes possédant ou non un ECG.Résultats et conclusion : 10 médecins non équipés et 7 médecins équipés ont participé à 2 focus groups distincts. Les principaux freins mis en évidence sont le risque médico-légal, le manque de temps, le manque de compétences dans l’interprétation du tracé, la proximité des cardiologues ou des services d’urgences, des indications limitées et un rôle décisionnel restreint, l’aspect économique et les difficultés techniques. Les pistes pouvant être proposées pour lever ces freins sont notamment une meilleure information du praticien sur les risques réels encourus du fait d’une erreur d’interprétation ou de la non réalisation de l’ECG, un gain de temps par la mise en place de consultations dédiées, un maintien à niveau des connaissances (ouvrages, sites internet, formations) et une aide à l’interprétation, une revalorisation de l’acte et une amélioration technique des appareils

Qualité relationnelle des couples gais et conduites sexuelles à risque

La présente étude teste l'hypothèse suivant laquelle la qualité relationnelle des couples gais est positivement associée à l'adoption de conduites sexuelles à risque réduit, dans les situations de monogamie et de non-monogamie. Des mesures d'ajustement relationnel et de comportements sexuels sont recueillies auprès de 29 couples (58 hommes) homosexuels de la région de Montréal. Conformément à l'hypothèse, la distribution des couples selon un index multifactoriel de risque indique une relation entre la satisfaction de couple et le niveau de risque encouru dans les relations sexuelles à l'intérieur et à l'extérieur du couple. Les résultats sont discutés à la lumière des données existantes sur la relation santé-qualité relationnelle chez les couples hétérosexuels.This study examines the hypothesis by which quality relationships among gay couples is closely related to the adoption of low-risk sexual behaviours, in monogamous and non-monogamous situations. Data was collected from 29 homosexual couples (58 men) of the Montréal area. The survey, which graded sexual conduct as well as adjustments made within the relationship, confirmed the author's hypothesis. Indeed, the distribution of couples according to a multifactorial risk index does in fact establish a connection between the couple's happiness and the level of risk during sexual relations within and outside the couple. These conclusions are discussed in light of existing data pertaining to the link between health and the quality of a relationship among heterosexual couples

Package 'blockseg'

Package for the software RThis package is designed to segment a matrix in blocks with constant values

Strong normal-incidence infrared absorption in self-organized InAs/InAlAs quantum dots grown on InP(001)

International audienceInAs self-assembled quantum dots in InAlAs matrix grown on InP001 substrates have been fabricated using Stranski-Krastanov growth mode. A strong in-plane polarized intraband absorption in the 10.6-20 m wavelength region has been observed and ascribed to a transition from the ground electron state to an excited state confined in the layer plane along the 110 direction. The absorption at normal-incidence reaches 7.8% for ten layers of n-doped quantum dots. The oscillator strength of the intraband transition is comparable to that achieved in quantum wells for a conduction band intersubband transition. The dependence of the intraband absorption on carrier concentration and temperature suggests a quantum-wire type confinement potential

Suitability assessment of a continuous process combining thermo-mechano-chemical and bio-catalytic action in a single pilot-scale twin-screw extruder for six different biomass sources

A process has been validated for the deconstruction of lignocellulose on a pilot scale installation using six types of biomass selected for their sustainability, accessibility, worldwide availability, and differences of chemical composition and physical structure. The process combines thermo-mechano-chemical and bio-catalytic action in a single twin-screw extruder. Three treatment phases were sequentially performed: an alkaline pretreatment, a neutralization step coupled with an extraction–separation phase and a bioextrusion treatment. Alkaline pretreatment destructured the wall polymers after just a few minutes and allowed the initial extraction of 18–54% of the hemicelluloses and 9–41% of the lignin. The bioextrusion step induced the start of enzymatic hydrolysis and increased the proportion of soluble organic matter. Extension of saccharification for 24 h at high consistency (20%) and without the addition of new enzyme resulted in the production of 39–84% of the potential glucose

Dynamic saturation of an intersublevel transition in self-organized InAs/In(x)A(1-x)lAs quantum dots

International audienceWe have observed a dynamic saturation of an intersublevel transition in InAs/InxAl1-xAs quantum dots related to the discrete nature of electron states using midinfrared femtosecond spectroscopy. This dynamic saturation is a consequence of the gradual filling of the discrete quantum-dot electron states due to the capture of electrons injected in the barrier. Our interpretation of the differential transmission experiments is confirmed by a comparison with a rate-equation model with the capture and intersublevel relaxation time as fit parameters yielding 10 ps and 1 ps, respectively. We discuss the mechanism responsible for these relaxation times

Optimization of DC reactive magnetron sputtering deposition process for efficient YSZ electrolyte thin film SOFC

International audienceYttria-stabilized zirconia (YSZ, ZrO2:Y2O3) thin films were deposited by reactive DC magnetron sputtering with a high deposition rate from a metallic target of Zr/Y in an argon/oxygen atmosphere. Plasma parameters and composition analysis of the gas phase reveal that the sputtering process in the "compound" mode is reached for a 2.5 sccm oxygen flow rate. Deposition onto silicon in "metal" mode at a flow rate close to the transition, allows obtaining at very high deposition rates (> 10 µm.h-1) a compact columnar stoichiometric crystallized YSZ film. When deposited on NiO YSZ commercial anode, the obtained coatings show the same properties. In spite of the complexity of the substrate (roughness and porosity), a compact and conformed layer was formed. Annealing treatments in air or hydrogen do not significantly alter the structure of the layers. Electrochemical test at 850°C with a screen-printed LSM (LaSrMnO3) cathode exhibits a satisfying gastightness (OCV=900 mV) and a maximum power density of 350 mW.cm-2

The Warburg Effect as a Type B Lactic Acidosis in a Patient With Acute Myeloid Leukemia: A Diagnostic Challenge for Clinicians

IntroductionThe Warburg effect (WE) is an uncommon cause of type B lactic acidosis (LA) due to a deregulation of carbohydrate metabolism in neoplastic cells where lactic fermentation predominates over oxidative phosphorylation regardless of the oxygen level.Case presentationWe report the case of a 57-year-old man presenting with concomitant acute myeloid leukemia and type B LA with asymptomatic hypoglycemia. We did not find arguments for a septic state, liver dysfunction, or acute mesenteric ischemia. The WE was suspected, and chemotherapy was immediately undertaken. We observed a rapid and sustained decrease in lactate level and normalization of blood glucose. Unfortunately, we noted a relapse of acute leukemia associated with WE soon after treatment initiation and the patient died in the Intensive Care unit.DiscussionSome patients may present complications directly related to an underlying hematological malignancy. The WE is one of these complications and should be suspected in patients with both hypoglycemia and LA. We propose a checklist in order to help clinicians manage this life-threatening complication. Before considering WE, clinicians should eliminate diagnoses such as septic shock or mesenteric ischemia, which require urgent and specific management.ConclusionThe diagnosis of WE can be challenging for clinicians in the Hematology department and the Intensive Care unit. Prompt diagnosis and rapid, adapted chemotherapy initiation may benefit patient survival

Optical properties of self-assembled InAs quantum islands grown on InP(001) vicinal substrates

International audienceWe have investigated the effect of misorientated InP001 substrates on the optical properties of InAs quantum islands QIs grown by molecular-beam epitaxy in the Stranski-Krastanow regime. Detailed temperature-dependent photoluminescence PL, excitation density PL, and polarization of photoluminescence PPL are studied. PPL shows a high degree of linear polarization near 40% for the nominally oriented substrate n and for the substrate with 2° off miscut angle toward the 110 direction (2° F), while it is near 15% for the substrate with 2° off miscut angle towards 010 direction (2° B), indicating the growth of InAs quantum wires on nominal and 2° F substrates and of InAs quantum dots on 2° B substrate. These island shapes are confirmed by morphological investigations performed by atomic force microscopy. The integrated PL intensity remains very strong at room temperature, as much as 36% of that at 8 K, indicating a strong spatial localization of the carriers in the InAs QIs grown on InP001